Classifications

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  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
  • A61L24/02—Surgical adhesives or cements; Adhesives for colostomy devices containing inorganic materials
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  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
  • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
  • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
  • A61B17/88—Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices
  • A61B17/8802—Equipment for handling bone cement or other fluid fillers
  • A61B17/8805—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it
  • A61B17/8811—Equipment for handling bone cement or other fluid fillers for introducing fluid filler into bone or extracting it characterised by the introducer tip, i.e. the part inserted into or onto the bone
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  • A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
  • A61L24/0005—Ingredients of undetermined constitution or reaction products thereof
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  • A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
  • A61L24/001—Use of materials characterised by their function or physical properties
• • A—HUMAN NECESSITIES
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  • A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
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  • A61L24/0015—Medicaments; Biocides
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  • A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
  • A61L24/001—Use of materials characterised by their function or physical properties
  • A61L24/0036—Porous materials, e.g. foams or sponges
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  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
  • A61L24/001—Use of materials characterised by their function or physical properties
  • A61L24/0042—Materials resorbable by the body
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  • A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
  • A61L24/0047—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material
  • A61L24/0052—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material with an inorganic matrix
  • A61L24/0063—Phosphorus containing materials, e.g. apatite
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  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
  • A61L24/0047—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material
  • A61L24/0073—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material with a macromolecular matrix
  • A61L24/0084—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material with a macromolecular matrix containing fillers of phosphorus-containing inorganic compounds, e.g. apatite
• • A—HUMAN NECESSITIES
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  • A61L24/00—Surgical adhesives or cements; Adhesives for colostomy devices
  • A61L24/04—Surgical adhesives or cements; Adhesives for colostomy devices containing macromolecular materials
  • A61L24/06—Surgical adhesives or cements; Adhesives for colostomy devices containing macromolecular materials obtained by reactions only involving carbon-to-carbon unsaturated bonds
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  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/02—Inorganic materials
  • A61L27/12—Phosphorus-containing materials, e.g. apatite
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/40—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material
  • A61L27/44—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix
  • A61L27/46—Composite materials, i.e. containing one material dispersed in a matrix of the same or different material having a macromolecular matrix with phosphorus-containing inorganic fillers
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
  • A61L27/00—Materials for grafts or prostheses or for coating grafts or prostheses
  • A61L27/50—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
• • A—HUMAN NECESSITIES
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  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
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  • A61P1/06—Anti-spasmodics, e.g. drugs for colics, esophagic dyskinesia
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  • A61L2300/00—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices
  • A61L2300/40—Biologically active materials used in bandages, wound dressings, absorbent pads or medical devices characterised by a specific therapeutic activity or mode of action
  • A61L2300/44—Radioisotopes, radionuclides
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  • A61L2400/00—Materials characterised by their function or physical properties
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  • A61L2400/00—Materials characterised by their function or physical properties
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  • A61L2430/00—Materials or treatment for tissue regeneration
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  • A61L2430/00—Materials or treatment for tissue regeneration
  • A61L2430/38—Materials or treatment for tissue regeneration for reconstruction of the spine, vertebrae or intervertebral discs

Definitions

• Naturally occurring bone is contains about 70% mineral (nanometer-sized calcium deficiency hydroxyapatite) and about 30% organic matrix (collagen, proteins etc ) Bone loss occurs as results of increased bone destruction (resorption by osteoclastic activity) relative to bone formation (by agmg or disease) Both bone resorption and formation occur continuously in the skeleton as part of normal skeletal function During this process packs of bone are being destroyed and rebuilt in a process called remodeling Osteoporosis is a disease characterized by low bone mass leading to an increased frequency of low energy fractures It is known that osteoporosis is a condition that features loss of the normal density of bone and fragile bone It leads to literally abnormally porous bone that is more compressible (e g , spongy) than dense (e g , brick) This disorder of the skeleton weakens the bone, which leads to an increase in the risk of breaking bones (bone fracture)
• Bones that are affected by osteoporosis can fracture with only a minor fall or injury that normally would not cause a bone fracture
• the fracture can be in the form of cracking (as in a hip fracture), or collapsing (as in a compression fracture of the vertebrae of the spme)
• the spme, hips, and wrists are common areas of osteoporosis related bone fractures, although osteoporosis-related fractures can also occur in almost any skeletal bone area
• Bisphosphonates which are analogues of naturally occurring pyrophosphate that contain a utrbon instead of an oxygen atom, are widely used in the treatment of osteoporosis in order to inhibit osteoclastic bone resorption Bisphosphonates have been observed to preferentially bind to bone mineral in areas that are actively undergoing remodeling After desorption in bone, bisphosphonates are liberated again only when the bone is resorbed (by osteoclasts)
• the most common adverse event with bisphosphonate treatment is gastrointestinal disturbance, including, e g , pain, diarrhea, and abdominal discomfort Given that treatment for osteoporosis is typically long term, compliance and tolerability (without side effect) are important Despite the fact that traditional approaches (mostly based on non-surgical therapies as a preventive measure) have been shown to be ineffective in alleviating pa
• a MIS technique allows for the same outcomes as conventional (open) surgery, but with additional benefits that include, e g , the avoidance of open invasive surgery in favor of closed (tmy incision) or local surgery, a reduction in surgical complications (muscle stripping, blood loss, etc ), a reduction m operative trauma (by soft tissue preservation) with less postoperative pain, a reduction in patient hospitalization time and, consequently, a significant reduction in costs, an increase in the speed of functional return to daily activities, a shorter recovery time (a few months instead of a year), and a few cosmetically tmy scars rather than one large scar
• CPC calcium phosphate cement
• compositions that can be used m kyphoplasty and vertebroplasty applications that avoid the complications associated with PMMA cement compositions
• the invention features a biocompatible, injectable, self-setting, cohesive, bone-bonding and remodeling calcium phosphate (CaP) composite material and its use in methods for vertebroplasty augmentation
• the CaP material is a nanocrystallme apatite (NCA) or a nano-low crystalline apatite (NLCA), which can be synthesized using, e g , a low temperature double decomposition technique or a high energy grinding technique
• the CaP material of the present invention may also include polymers or other chemical bonding agents, such as polylactic acid (PLA) and hydroxyethyl methacrylate (HEMA) monomers Unlike PMMA-contaming cements, the CaP materials of the present invention can be remodeled m vivo and do not contain volatile monomers that can be "leached" into the body of a patient
• the invention features a method for performing vertebroplasty on a vertebral body by injecting (e g , through a 16 gauge needle or less, e g , an 11 gauge needle) a flowable bone cement into at least one vertebral body (e g , by directly injecting into the vertebral body or by injecting into the vertebral body after creating a cavity) of a mammal (e g , a human or a non-human mammal) and allowing the flowable bone cement to harden
• the flowable bone cement includes a calcium phosphate material (e g , a nanocrystalline apatitic calcium phosphate, such as a NCA and a NLCA), a radio-opaque agent, and a pharmaceutically acceptable fluid in an amount sufficient to produce the flowable bone cement
• the calcium phosphate can be selected from amorphous calcium phosphate, poorly crystalline calcium phosphate, hydroxyapatite, carbonated apatite (calcium deficient a
• the flowable bone cement further includes a cohesiveness agent, an osteogenic agent, or a medicinal agent 1 he cohesiveness agent can be selected from the group consisting of a) one or more polymers selected from polysaccharides, nucleic acids, carbohydrates, proteins, polypeptides, poly( ⁇ -hydroxy acids), poly(lactones), poly(amino acids), poly(anhyd ⁇ des), poly(orthoesters), poly(anhydnde co lmides), poly(orthocarbonates), poly( ⁇ -hydroxy alkanoates), poly(dioxanones), poly(phosphoesters), poly(L-lactide) (PLLA), poly(D,L-lactide) (PDLLA), polyglycolide (PGA), poly(lactide-co-glycohde (PLGA), poly(L-lactide-co-D, L- lactide), poly(D,L lactide-co-trimethylene carbonate), polyhydroxybutyrate (PHB), poly
• the pharmaceutically acceptable fluid is selected from water, saline, a phosphate buffer, a biological fluid, in particular, blood or a fluid that includes blood components, and glycerol
• the method also includes injecting the flowable bone cement into two or more vertebral bodies
• the vertebral body may be fractured or osteoporotic bone
• the calcium phosphate material has crystals within the range of 30-80 nm (e g , 30-50 nm) or has a crystallmity index value of less than 60% (preferably less than 50%, and more preferably less than 40%) relative to hydroxyapatite
• the method involves a minimally invasive surgery, which entails the formation of one or more tmy (less than 2 inches, more preferably less than 1 inch) incisions that allow insertion of a syringe needle through the incision to the site of the vertebral body
• the flowable bone cement can be administered through a syringe, which eliminates the need for a large entry point into the patient
• the method reduces surgical complications (e g muscle stripping, blood loss etc ), reduces operative trauma (e g , by preserving soft tissue) and postoperative pain, reduces patient hospitalization time, increases the speed of functional recovery and decreases recovery time (c g , to a few months rather than a year or more), and leaves a few tiny scars instead of one large scar
• a second aspect of the invention features a flowable bone cement that mcludes a calcium phosphate material (e g , a nanocrystalline apatite (NCA) or a nano-low crystalline apatite (NLCA), which can be synthesized using, e g , a low temperature double decomposition technique or a high energy grinding technique) and a pharmaceutically acceptable fluid (e g , water, saline, a phosphate buffer, a biological fluid, in particular, blood or a fluid that includes blood components, and glycerol), wherein said flowable bone cement is injectable (e g , through a needle having a size of at least 16 gauge or less (e g , 11 gauge or less)) and hardens in less than 1 hour at 37 °C and, after hardening, has a compressive strength of 1 mPa or greater and is resorbable in vivo
• the flowable bone cement mcludes a radio-opaque agent or
• the calcium phosphate has crystals withm the range of 30 80 nm (e g , 30 50 nm) or has a crystallmity index value of less than 60% (preferably less than 50% and more preferably less than 40%) relative to hydroxyapatite
• a third aspect of the invention features a kit that includes the flowable bone cement of the second aspect of the invention and a syringe for delivery of the flowable bone cement
• a fourth aspect of the invention features a method for making nanocrystallme apatite (NCA) and nano-low crystalline apatite (NLCA) CaP materials using a low temperature double decomposition technique or a high energy grinding technique and adding a cohesiveness agent or by chemically bonding the CaP material using a polymer (e g , polylactic acid) or, e g , HEMA, to form a flowable bone cement that is capable of hardening at 37 0 C in less than 2 hours, preferably less than 1 hour, more preferably less than 30 minutes, and most preferably between 10 and 30 minutes and that, prior to hardening, can be injected using a 16 gauge or less needle (e g , an 11 gauge needle)
• the material has a compressive strength of 1 mPa or greater (e g , a compressive strength in the range of about 1 MPa to about 150 MPa (e g , 2, 10, 20, 30, 40, 50, 60, 70, 80, 90, 100, or
• a "biocompatible" substance is one that does not produce an unacceptable or undesirable physiological response, e g , an immune response, in the recipient
• cohesiveness means the ability of CaP composite to maintain its shape without loss of mass A composite is deemed cohesive if greater than 90% of its initial mass and volume are retained within its initial shape dimension following incubation in an aqueous environment for at least 10 minutes
• bioresorabable is meant capable of being degraded or metabolized in vivo by the body and resorbed and/or eliminated through normal excretory routes by the body Such metabolites or break-down products should be substantially non-toxic to the body
• a “cohesiveness agent” means an additive that, when included in a CaP composite of the invention, improves the ability of the CaP composite to maintain its cohesiveness
• Preferred cohesiveness agents include polymers selected from polysacchandes, nucleic acids, carbohydrates, proteins, polypeptides, poly( ⁇ - hydroxy acids), poly(lactones), ⁇ oly(amino acids), poly(anhyd ⁇ des),
• ⁇ igure 1 is an X-ray image showing injection of the calcium phosphate matenal of the present invention (containing a radio-opaque agent, bottom needle) into a vertebral body of a human
• Figure 2 is an X-ray image showing dispersal of the calcium phosphate material mto the vertebral body (bottom needle) following injection
• Figure 3 is a photograph showing an external view du ⁇ ng injection of the calcium phosphate material into the vertebra of a human
• the present invention features a biocompatible, injectable, self-setting, cohesive, bone-bonding, and remodeling calcium phosphate composite (CaP Comp) material that can be used for vcrtcbroplasty augmentation and kyphoplasty
• the present invention features several CaP formulations prepared by creating a chemical bond between an adhesive agent (e g , a polymer) and a CaP material
• the CaP component is not just physically mixed with the adhesive agent but is chemical bonded, e g , by using a low temperature double decomposition wet chemistry process (see, e g , U S Patent No 5,783,217, incorporated herein by reference), a high energy grinding process (see, e g , U S Patent Nos 7,318,841 and 6,840,961, both of which are incorporated herein by reference), or both
• the CaP matenal is formulated as a nano-crystalhne apatite (NCA) or a nano-low crystalline apatite (NLCA) These apatites are synthesized, e g , by using the low temperature double decomposition technique discussed above
• the CaP composites of the present invention can also be prepared using one or more polymers, including, e g , polylactic Acid (PLA), which are polymerized with the CaP by physical fixation
• the CaP composites of the piesent invention can also be prepared using one or more polymers, including, e g , hydroxyethyl methacrylate (HEMA) monomers, which are used to polymerize the CaP using a chemical linkage (CaP Co-Polymerization (covalent binding))
• the chemical bond may be formed through phosphate ions, which may partially replace the hydroxyl ions of apatite
• the CaP composites of the present invention can be remodeled into bone Moreover, the CaP composites of the invention do not contain volatile monomers that can be "leached" away from the composite after it has been applied to the grafting site (e g , in vertebroplasty or kyphoplasty applications), and thus, the present CaP composites can substantially reduce the potential for significant side effects observed in PMMA applications
• the CaP composites of the present invention can be formulated for injection (injectable), can be formulated as a formable material, which can be molded into a desired shape (e g , formable) before implantation or at the implant site, and is biodegradable Furthermore, the CaP composites of the invention can be used in therapeutic applications (e g , the treatment of vertebral compression fractures) or for prophylactic applications (c g , the augmentation of bone, such as osteoporotic bone (e g , vertebrae))
• the percutaneous injection of a CaP composite of the invention into an osteoporotic vertebral body can substantially increase its fracture strength and stiffness
• injection of a CaP composite of the invention into a vertebral compression fracture can partially restore vertebral height and substantially prevent further vertebral collapse while avoiding potential problems associated with the use of PMMA
• the CaP composites of the present invention can also be used to augment the implantation of pedicle screws into osteoporotic human vertebrate
• the CaP composites of the invention provide improved stability of pedicle screws in osteoporotic human vertebrae both for pullout and cyclic loading relative to other fixation compositions
• the CaP composites of the invention include a biocompatible cohesiveness agent
• the cohesiveness agent includes one or more polymers selected from polysaccharides, nucleic acids, carbohydrates, proteins, polypeptides, poly( ⁇ hydroxy acids), poly(lactones), poly(ammo acids), poly(anhydndes), poly(orthoesters), poly(anhydnde-co-imides), poly(orthocarbonates), poly( ⁇ hydroxy alkanoates), poly(dioxanones), poly(phosphoesters), poly(L-lactide) (PLLA), poly(D L-lactide) (PDLLA), polyglycohde (PGA), poly(lactide-co-glycohde (PLGA), poly(L-lactide-co-D, L-lactide), poly(D,L-la ⁇ ide- ⁇ o-t ⁇ mefhylene carbonate), polyhydroxybutyrate (PHB), poly( ⁇ -caprolacto ⁇ e),
• the CaP composites may also include a physiologically-acceptable fluid which, when added to the dry components of the composition, produces a self-hardenmg paste or putty (e g , the paste or putty hardens in about 10 minutes to about 2 hours, preferably in about 10 minutes to about 1 hour, and more preferably in about 10 minutes to about 30 mrnutes)
• suitable physiologically-acceptable fluids include but are not limited to water, saline, glycerol, and phosphate buffers
• the fluid can be a biological fluid, e g , any treated or untreated fluid (including a suspension) associated with living organisms, particularly blood, including whole blood, warm or cold blood, and stored or fresh blood, treated blood, such as blood diluted with at least one physiological solution, including but not limited to saline, nutrient, and/or anticoagulant solutions, blood components, such as platelet concentrate (PC), apheresed platelets, platelet-
• PC platelet concentrate
• the CaP composites of the invention demonstrate flow characteristics that allow them to be easily injected Varying amounts of fluid may be added to the dry ingredients of the CaP composites to produce a paste having the desired characteristics
• Varying amounts of fluid may be added to the dry ingredients of the CaP composites to produce a paste having the desired characteristics
• 0 5-2 0 cc of fluid per gram of powder is used to prepare d paste that is formable, i e , capable of being molded and retaining its shape
• the paste is injectable, i e , capable of passing through a 16- to 18- gauge needle
• the paste can also be prepared for delivery through a catheter (e g , a catheter having a 7-15 gauge needle, and more preferably a 7, 8, 9, 10, 11, 12, 13, 14, or 15 gauge needle) Once injected, the CaP composite retains its shape and position
• the CaP composite when hydrated, produces a formable, self-hdrdemng paste, which is moldable and cohesive when applied to an implant site in vivo, or an injectable, self-hardening composition that can be injected at the site of bone repair (e g , a vertebral body), both the formable and the injectable compositions are capable of hardening at the implant site Again, the compositions retain their shape and position once injected
• the paste hardens to form a CaP composite (e g , a NCA or a NCLA) having significant compressive strength
• the CaP composite may be implanted or injected in vivo in paste form or as a hardened CaP composite (e g , molded into a desired shape, such as the shape of a bone defect to be replaced)
• the CaP composites of the invention can be used to repair bone, e g , damaged bone, such as damaged vertebral bone
• the CaP composite additionally includes a biologically
• Anti-cancer agents include, without limitation, alkylating agents, platinum agents, antimetabolites, topoisomerase inhibitors, antitumor antibiotics, antimitotic agents, aromatase inhibitors, thymidylate synthase inhibitors, DNA antagonists, farnesyltransferase inhibitors, pump inhibitors, histone acetyltransferase inhibitors, metalloprotemase inhibitors, ⁇ bonuoleoside reductase inhibitors, TNF alpha agonists, TNF alpha antagonists, endothelin A receptor antagonists, retinoic acid receptor agonists, lmmuno-modulators, hormonal agents, antihormonal agents, photodynamic agents, and tyrosine kinase inhibitors
• the CaP composite includes deminerahze
• the CaP composite includes a contrast agent (c g , a barium apatite contrast agent, see, e g , U S Patent Application Publication No 2005/0257714, incorporated herein by reference)
• a contrast agent c g , a barium apatite contrast agent, see, e g , U S Patent Application Publication No 2005/0257714, incorporated herein by reference
• the CaP composites include calcium phosphate components that have a Ca/P ratio of less than 1 67
• the CaP composites harden to form a composition having an overall Ca/P ratio in the range of 1 0 1 67, preferably 1 3-1 65, more preferably 1 4-1 6, and most preferably close to that of naturally occurring bone, that is m the range of 1 45 to 1 67
• the CaP composites have a Ca/P ratio of equal to or less than about 1 5
• the CaP composites of the invention exhibit a compressive strength of equal to or greater than about 1 or 2 MPa
• the compressive strength is m the range of about 1 MPa to about 150 MPa (e g , 20, 30, 40, 50, 60, 70, 80, 90, or 100 MPa)
• the compressive strength is 120 MPa or greater (e g , 120 to 150 MPa)
• the CaP component of the CaP composites has an average crystalline domain size of less than 100 run (e g , in the range of between about 1 nm to about 99 run, preferably 50 run or less, more preferably 40, 30, 20, 10 run or less)
• the CaP composite includes a radio-opaque agent
• radio-opaque agents include barium (e g , barium carbonate and barium sulfate), iodine (e g , methyl methacrylate, 2-(2'-iodobenzoyl)-ethyl methacrylate), lanthanum oxide, and zirconium dioxide
• the radio opaque agent is present in the CaP composite in an amount of 20% or less by weight, preferably 5% or less by weight, and more preferably 1% or less by weight
• the CaP composites of the present invention may include a biocompatible cohesiveness agent
• suitable biocompatible cohesiveness agents include polymers selected from polysaccharides, nucleic acids, carbohydrates, proteins, polypeptides, poly( ⁇ -hydroxy acids), poly(lactones), poly(amino acids), poly(anhyd ⁇ des), poly(orthoesters), poly(anhyd ⁇ de-co-imides), poly(orthocarbonates), poly( ⁇ -hydroxy alkanoates), poly(dioxanones), poly(phosphoesters), poly(L-lactide) (PLLA), poly(D,L-lactide) (PDLLA), polyglycohde (PGA), poly(lactide co glycolide (PLGA), poly(L-lac ⁇ de-co-D, L- lactide), poly(D,L lactide-co-trimethylene carbonate), polyhydroxybutyrate (PHB), poly( ⁇ -caprolactone), poly( ⁇ -valerolactone), poly( ⁇ -vale
• Preferred cohesiveness agents also include algmic acid, arable gum, guar gum, xantham gum, gelatin, chitin, chitosan, chitosan acetate, chitosan lactate, chondroitm sulfate, N,O-carboxymethyl chitosan, a dextran (e g ,
• the biocompatible cohesiveness agent may be added to the CaP composites ot the invention in varying amounts and at a variety of stages during the production of the powder component
• the biocompatible cohesiveness agent is present in a range of about 1 to 50 weight percent
• the biocompatible cohesiveness agent is present m an amount less than or equal to 40 weight percent of the powder component, preferably less than or equal to 30 weight percent, more preferably less than or equal to 20 weight percent, and most preferably less than or equal to 10 weight percent
• the biocompatible cohesiveness agent is present in an amount of about 5 weight percent
• the CaP composite includes DBM
• the DBM content of the bone implant material is so high that, notwithstanding the fo ⁇ nability and cohesiveness provided by the calcium phosphate component of the composite, a cohesiveness agent may be desirable to further augment the mechanical strength of the bone implant material during implantation
• the biocompatible cohesiveness agent is present in an amount of about 10 weight percent of the powdei component
• the calcium phosphate composition includes DBM in an amount of about 40 to 50 weight percent, a calcium phosphate component in an amount of about 35 to 45 weight percent, a cohesiveness agent in an amount of about 5 to 10 weight percent, and an effervescent agent in an amount of about 5 to 10 weight percent, such that the combination of all of the components totals 100 weight percent
• the biocompatible cohesiveness agent may be added to the DBM particles as a solution, for example, the cohesiveness agent can coat the DBM particles
• the biocompatible cohesiveness agent may be added to the powder component of the composition, including the DBM particles and the calcium
• the CaP composite of the invention can also include a biologically active agent
• the biologically active agent should remain active witlim the paste during manufacture of the CaP composite, or be capable of being subsequently activated or re-activated following manufacture of the CaP composite
• the biologically active agent can be added at the time of implantation of the CaP composite (whether as a moldable or injectable paste or as a hardened cement) into a host or following hardening at 37 0 C in an aqueous environment
• Biologically active agents that can be incorporated into the CaP composites of the invention include, without limitation, orgamc molecules, inorganic materials, proteins, peptides, nucleic acids (e g , genes, gene fragments, gene regulatory sequences, and antisense molecules), nucleoproteins, polysaccharides, glycoproteins, and lipoproteins
• Classes of biologically active compounds that can be incorporated into the compositions of the invention include, without limitation, anti-cancer agents, antibiotics, analgesics, anti
• the CaP composites can also include medicinal agents, e.g , antibiotics, such as aminoglycosides (e g., gentamicin, tobramycin, netilmicin, streptomycin, amikacin, neomycin), bacitracin, corbapenems (e.g., imipenem/cislastatin), cephalosporins, colistin, methenamine, monobactams (e.g., aztreonam), penicillins (e.g., penicillin G, penicillin V, methicillin, natcillin, oxacillin, cloxacillin, dicloxacillin, ampicillm, amoxicillin, carbemcillm, ticarcillm, piperacillin, mezlocillin, azlocillin), polymyxin B, quinolones, and vancomycin, and bacteriostatic agents such as chloramphenicol, clindanyan, macro
• Enzyme inhibitors are substances that inhibit an enzymatic reaction
• enzyme inhibitors include, e g , edrophonium chloride, N-methylphysostigmme, neostigmine bromide, physostigminc sulfate, tacrine, tacrine, 1 -hydroxy maleate, lodotubercidm, p- bromotetramisole, 10-(alpha-diethylammopropionyl)-phenothiazine hydrochloride, calmidazohum chloride hemicholinmm-3, 3,5-dimtrocatechol, diacylglycerol kinase inhibitor I, diacylglycerol kinase inhibitor II, 3 phenylpropargylamine, N 6 monomethyl-L-argjmne acetate, carbidopa
• Antihistamines that can be included in CaP composites of the invention include, e g , py ⁇ lamine, chlorpheniramine, and tetrahydrazoline, among others
• Anti-inflammatory agents that can be included in CaP composites of the invention include, e g , corticosteroids, nonsteroidal anti-mflammatory drugs (e g , aspirin, phenylbutazone, mdomethacin, sulmdac, tolmetm, lbuprofen, piroxicam, and fenamates), acetaminophen, phenacetin, gold salts, chloroqume, D-Pemcillamme, methotrexate colchicine, allopurinol, probenecid, and sulfinpyrazone
• Muscle relaxants that can be included m CaP composites of the invention include, e g , mephenesin, methocarbomal, cyclobenzaprme hydrochloride, t ⁇ hexylphenidyl hydrochloride, levodopa/carbidopa and bipe ⁇ den
• Anti-spasmodics that can be included in CaP composites of the invention include, e g , atropine, scopolamine oxyphenomum, and papave ⁇ ne
• Analgesics that can be included m CaP composites of the invention include, e g , aspirin, phenybutazone, ldomethacin, sulmdac, tolmetic, lbuprofen, piroxicam, fenamates, acetaminophen, phenacetin, morphine sulfate, codeine sulfate, meperidine, nalorphine opioids (e g , codeine sulfate, fentanyl citrate, hydrocodone bitartrate, loperamide, morphine sulfate, noscapmc, norcodeme, normorphine, thebaine, nor-bmaltorphimme, buprenorphme, chlornaltrexamme, funaltrexamione, nalbuphine, nalorphine, naloxone, naloxonazine, naltrexone, and nalt ⁇
• Ophthalmic agents that can be included in CaP composites of the invention include, e g , sodium fluorescein, rose bengal, methacholme, adrenaline, cocaine, atropine, alpha-chymotrypsin, hyaluronidase, betaxalol, pilocarpine, timolol, timolol salts, and combinations thereof
• Prostaglandins which are art recognized as a class of naturally occurring chemically related, long-cham hydroxy fatty acids that have a variety of biological effects, can also be included m CaP composites of the invention
• Anli-depressdnts are substances capable of preventing or relieving depression
• anti-depressants that can be included in CaP composites of the invention include, e g , lmipramme, armt ⁇ ptyline, nortriptyline, protriptyhne, desipramme, amoxapine, doxepm, maprotihne, tranylcypromine, phenelzine, and isocarboxazide Trophic factors are factors whose continued presence improves the viability or longevity of a cell Trophic factois that can be included m
• CaP composites of the invention include, without limitation, platelet-derived growth factor (PDGP), neutrophil-activatmg protein, monocyte chemoattractant protein, macrophage- inflammatory protein, platelet factor, platelet basic protein, and melanoma growth stimulating activity, epidermal growth factor, transforming growth factor (alpha), fibroblast growth factor, platelet-derived endothelial
• Hormones that can be included in CaP composites of the invention include, e g , estrogens (e g , estradiol, estrone, est ⁇ ol, diethyl stibestrol, qumestrol, chlorotnamsene, ethinyl estradiol, mestranol), anti-estrogens (e g , clomiphene, tamoxifen), progestins (e g , medroxyprogesterone, norethindrone, hydroxyprogesterone, norgestrel), antiprogestm (mifepristone), androgens (e g, testosterone cypionate, fluoxymesterone, danazol, testolactone), anti-androgens (e g , cyproterone acetate, fiutamide), thyroid hormones (e g , t ⁇ iodothyronne, thyroxine, propylthiouracil
• the biologically active agent is desirably selected from the family of proteins known as the transforming growth factors beta (TGF- ⁇ ) superfamily of proteins, which includes the activins, inhibins, and bone morphogenetic proteins (BMPs)
• TGF- ⁇ transforming growth factors beta
• BMPs bone morphogenetic proteins
• the active agent includes at least one protein selected from the subclass of pioteins known generally as BMPs, which have been disclosed to have osteogenic activity, and other growth and differentiation type activities
• BMPs include BMP proteins BMP-2, BMP-3, BMP-3b, BMP-4, BMP-5, BMP-6 and BMP- 7, disclosed for instance in U S Patent Nos 5,108,922, 5,013,649, 5,116,738, 5,106,748, 5,187,076, and 5,141,905, BMP-8, disclosed in PCT publication WO 91/18098, and BMP-9, disclosed in PCT publication WO 93/00432, BMP-IO, disclosed in PCT application WO 94
• the biologically active agent may be recombmantly produced, or purified from a protein composition
• the active agent if a TGF- ⁇ , such as a BMP, or other dimenc protein, may be homodimenc, or may be heterodimeric with other BMPs (e g , a heterodimer composed of one monomer each of BMP-2 and BMP 6) or with other members of the TGF ⁇ superfamily, such as activins, inhibins and TGF- ⁇ l(e g , a heterodimer composed of one monomer each of a BMP and a related member of the TGF- ⁇ superfamily)
• BMPs e g , a heterodimer composed of one monomer each of BMP-2 and BMP 6
• TGF- ⁇ superfamily such as activins, inhibins and TGF- ⁇ l(e g , a heterodimer composed of one monomer each of a BMP and a related member of the TGF-
• the biologically active agent may further include additional agents such as the Hedgehog, Frazzled, Chordin, Noggin, Cerberus and Follistatm proteins These families of proteins are generally described in Sasai ct al , Cell 79 779-790 (1994) (Chordin), PCT Patent Publication WO 94/05800 (Noggin), and Fukui et al , Devel Biol 159 131 (1993) (Follistatm) Hedgehog proteins are described in WO 96/16668, WO 96/17924, and WO 95/18856
• the Frazzled family of proteins is arecently discovered family of proteins with high homology to the extracellular binding domain of the receptor protein family known as Frizzled
• Frizzled family of genes and proteins is described in Wang et al , J Biol Chem 271 4468-4476 (1996)
• the active agent may also include other soluble receptors, such as the truncated soluble receptors disclosed in PCT patent publication WO 95/07982
• the amount of a biologically active agent included in the CaP composite can be in the range of from about 0 1 ng to about 10 0 g per kg, preferably about 1 0 ⁇ g to about 1000 0 mg per kg, most preferably about 10 0 ⁇ g to about 10 0 mg per kg
• Biologically active agents can be introduced into the CaP composites of the invention during or after its formation Agents may conveniently be mixed into the compositions prior to setting Alternatively, the CaP composite may be shaped and hardened and then exposed to the therapeutic agent m solution This particular approach is particularly well suited for proteins, which are known to have an affinity for apatitic materials
• a buffer solution containing the biologically active agent may be employed, instead of water, as the aqueous solution in which the self-hardening paste is, for example, irrigated prior to implantation
• Buffers may be used m any pH range, but most often will be used in the range of 5 0 to 8 0 m preferred embodiments the pH will be compatible with prolonged stability and efficacy of the desired therapeutic agent and, m most preferred embodiments, will be in the range of 5 5 to 7 4
• Suitable buffers include, but are not limited to, carbonates, phosphates (e g , phosphate buffered salme), and organic buffers such as Tns, HEPES
• the biologically active agent is DBM
• DBM is an organic, osteoinductive material most commonly obtained from long bone chips deminerahzed by acid treatment
• the acid treatment dissolves inorganic mineral components and acid-soluble proteins in the bone, leaving behind a collagen matrix as well as acid-msoluble proteins and growth factors (see, e g , Glowacki et al (1985) CIm Plast Surg 12(2) 233-241, Covey et al (1989) Orthop Rev 17(8) 8 5 7 863)
• the residual acid-msoluble proteins and growth factors are osteoinductive factors, such as bone morphogenic proteins (BMPs) and transforming growth factors (TCJFS)
• BMPs bone morphogenic proteins
• TCJFS transforming growth factors
• DBM is osteoinductive, fully resorbable, and, when used in combination with the calcium phosphate component of the CaP composites described herein, yields bone implant materials that are highly biocompatible because they closely mimic the chemical composition of natural bone
• DBM costs less than many
• the DBM employed in the CaP composites of the invention is pieferably derived from autogenic or allogenic sources
• DBM may be obtained by acid treatment of long bone chips, a process well known to those of ordinary skill in the art
• commercially available DBM may be used (e g , DBM available from Allosource, American Red Cross, Musculoskeletal Transplant Foundation, Regeneration Technologies, Inc , and Osteotech, Inc )
• the DBM m the bone implant materials is piesent in an amount between about 10 and about 70 weight percent of the powder component
• the DBM is present in an amount equal to about 6 0 weight percent of the powder component
• the DBM is present in an amount between about 1 and about 50 weight percent of the powder component
• the DBM is present in an amount less than or equal to about 20 weight percent of the powder component
• the DBM is present in an amount less than or equal to about 15 weight percent of the powder component
• the amount of DBM in a given composition will vary depending upon the amount of the biocompatible cohesiveness agent, as well as the intended use and desired charactenstics of the CaP composite
• the cohesiveness agent and the DBM are present in the CaP composite in a ratio of about 1 1 (e g , m an amount in the range of about 0 5 and about 20 weight percent of the powder component), preferably about 1 5, more preferably about 1 10, and most preferably about 1 20
• the cohesiveness agent is present in an amount of about 5 weight percent or less
• a preferred calcium phosphate powder composition includes about 15 weight percent DBM and about 85 weight percent calcium phosphate powder having between about 1 to about 10 weight percent cohesiveness agent and effervescent agent
• Another preferred calcium phosphate powder composition includes about 45 weight percent DBM, about 45 weight percent calcium phosphate powder and about 10 weight percent biocompatible cohesiveness agent
• the DBM particles may be of various sizes and physical forms As with the amount of DBM, the size and form of the DBM particles will vary depending upon the intended use of the bone implant material In some embodiments, the DBM particles have a longest dimension measuring between about 35 ⁇ m and about 850 ⁇ m and may further have an aspect ratio of less than about 5 In other embodiments, the DBM particles are fibrous in nature In some embodiments, these DBM fibers have a length between about 50 ⁇ m and about 3mm In other embodiments, the DBM
• NCA Nano Crystalline Apatite
• NCA nano particle is obtained Activate NCA powder (at 120 0 C during 2 hours) by removing excessive moisture (about 3 to 10 %)
• crystallinity index of NCA produced is estimated (by comparing with hydroxyapatite) to be around 60% with the nano-size crystal range 30-80 nm
• NLCA nano-particle is obtained Activate NLCA powder (at 120 0 C during 2 hours) by removing excessive moisture (about 3 to 10 %)
• the crystallinity index of NLCA produced is estimated (by comparing with hydroxyapatite) to be around 50% with nano-size crystal range 30-50
• NLCA nano-particle is obtained Activate NLCA powder (at 120 0 C during 2 hours) by removing excessive moisture (about 3 to 10 %)
• the crystallmity index of NLCA produced is estimated (by comparing with hydroxyapatite) to be around 40% with nano-size crystal range 30-50 nm
• NCA and/or NLCA apatite (NCA and/or NLCA) powder according to Example 1, 2, 3 or 4 Dissolve about 25g PLA (Polylactic Acid) powder m a solvent (acetone for example) in order to obtain a homogenous liquid
• HEMA Hydroxyethyl Methacrylate
• Solution 1 Add all of solution 1 to powder 1, at room temperature and stir vigorously to obtain emulsion of Apatite-HEMA
• the emulsion is vacuum dried at 80 °C, for 4h to remove all residual solvent by evaporation process
• the irreversible link between the ethyl emc bond of Apatile-HEMA produces a hydrophilic material that forms a colloid-like material when mixed with hydration media (for example, water or any other pharmaceutically acceptable liquid desc ⁇ bed herein)
• hydration media for example, water or any other pharmaceutically acceptable liquid desc ⁇ bed herein
• CaP cement powder was mixed with 5 % (w/w) Sodium Algmate powder CaP material was injected into two adult cadaveric vertebral bodies to assess the imaging capabilities (radiopacity) of paste under fluoroscopy
• the hydration media was physiological salme with 20% Renografin 60 (organically bond Iodine) solution in order to increase radiopacity capacity
• CA CaP Matrix with Cohcsiveness Agent
• the CA used is sodium algmate with the ratio of 1 to 20 w/w% CaP Algmate (2 w/w %) was previously injected into sheep lumbar (L3-L4) vertebrae (after conducting the defect) At 6 month time point, no signs of acute or chrome inflammation observed Histology analysis confirmed remodeling and osseomtegration on both stained sections and microiadiographs Larger quantity of new bone was present and organized in a concentric lamellar pattern
• CaP Matrix with Osteoinductive Agents CaP materia! made according to the recipe developed previously (see, e g , U S Patent No 7,318,841, incorporated herein by reference)
• the OI used is demmeralized bone matrix (DBM) with various ratios, e g , 1 1 calcium phosphate material (CaP) DBM, 2 1 (CaP DBM), 3 1 (CaP DBM), 4 1 (CaP DBM), 5 1 (CaP DBM), and 10 1 (CaP DBM)
• DBM demmeralized bone matrix
• the CaP/DBM composites are to be injected into sheep lumbar (L3-L4) vertebrae (after conducting the defect) At 6 month time point, the injection site will be examined for signs of acute or chronic inflammation Histology analysis, using, e g , stained sections and microradiographs, will be undertaken to confirm that remodeling and osseointegration has occurred
• the MA used is different kinds of antibiotics with various ratios (e g , 2 1 (CaP MA), 10 1 (CaP MA), 20 1 (CaP MA), and 50 1 (CaP MA)
• Bioresorbable, biocompatible, injectable, self setting, high-strength, bone- bonding calcium phosphate combination bone graft materials (i e , CaP composites) for the treatment of osteoporotic bone is produced.
• CaP composites were tested for applicability for Vertebroplasty in a human cadaver model CaP composites were prepared by mixing dry powders of a high strength, fast setting calcium phosphate and carboxyl methyl cellulose (CMC) The dry powders were hydrated and mixed with an iodine based contrast agent, ISOVUE (Bracco Diagnostics), until a smooth paste was formed Percent CMC, CMC molecular weight, and hydration volume were varied to create different CPC formulations
• Each CaP composite formulation was loaded into a delivery syringe attached to an 11 gauge vertebroplasty needle and delivered under fluoroscopy into a separate vertebral body CaP composites were evaluated for ease of visualization, ease of delivery, and dispersion A PMMA designed for vertebroplasty use (Cook) was used as a reference
• Vertebroplasty involves injecting the bone cement of the present invention into small holes in weakened vertebrae to strengthen the spinal bones making them less likely to fracture again and providmg pam relief Using image-guidance, a hollow needle called a trocar is passed through the skm into the spinal bone and the bone cement of the present invention is then injected into the vertebra
• Kyphoplasty is a minimally invasive spmal surgery procedure used to treat painful, progressive vertebral compression fractures (VCFs)
• VCFs progressive vertebral compression fractures
• a VCF is a fracture in the body of a vertebra, which causes it to collapse In turn, this causes the spinal column above it to develop an abnormal forward curve VCFs may be caused by osteoporosis (an age-related softening of the bones) or by the spread of tumor to the vertebral body Certain forms of cancer can also weaken bone and cause the same problems
• a balloon is first inserted through the tube and into the vertebral body of a fractured vertebra where it is inflated to restore the height and shape of the vertebral body
• the balloon is then removed This is followed by injection of a bone cement of the present invention mto the cavity formed by the balloon to strengthen the vertebra
• the procedure may be performed with the patient lying face down on the operating room table and under intravenous sedation X-ray machines (e g , one, two, or more used together) can be used to show the collapsed bones
• intravenous sedation X-ray machines e g , one, two, or more used together
• the surgeon makes two small (less than 3 mm) incisions m the back
• a tube is inserted into the center of the vertebral body to the site of the fractured bone
• the balloon tamp is then inserted down the tube and inflated This pushes the bone back to its normal height and shape Inflation of the balloon creates a cavity in the vertebral body, which the surgeon
• kyphoplasty be performed soon after a VCF happens to best restore vertebral body height and size
• severe osteoporosis may cause other fractures at other levels of the spme
• Patients can also take bone strengthening medications during treatment If more vertebrae collapse, kyphoplasty in conjunction with the bone cement of the present invention can be used at those other levels Kyphoplasty tends to help prevent additional fractures by keeping the spme aligned in its native upright position

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